Mai K T, Ford J C, Yazdi H M, Perkins D G, Commons A S
Department of Laboratory Medicine, The Ottawa Hospital, Ontario, Canada.
Pathol Res Pract. 2000;196(8):533-40. doi: 10.1016/s0344-0338(00)80025-4.
Recent immunohistochemical studies have identified different antisera that have various degrees of sensitivity and specificity for papillary thyroid carcinoma (PTC). In this study, we performed immunostaining for CK, EMA, HBME, CD57 and CD15 in PTC, and benign thyroid nodular lesions to compare the sensitivity and the specificity of these antisera for PTC. In addition, we studied the patterns of immunostaining of these antisera in benign nodular thyroid lesions displaying a fine chromatin pattern, foci of cells with nuclear grooves, and optically clear nuclei. Fifty-five PTC (composed of 30 papillary variants and 25 follicular variants), 5 follicular carcinomas, 30 follicular adenomas, and 20 thyroid nodular lesions (5 papillary variants and 15 follicular variants) were submitted for immunostaining with CK, EMA, HBME, CD57, and CD15. CK and HBME showed the highest sensitivity and specificity for PTC when an arbitrary cutoff of more than 10% positive cells was considered as positive diagnostic immunostaining for these sera. The other antisera were less sensitive and less specific. One case of PTC showed negative HBME but positive CD15, whereas three papillary variants and two follicular variants of benign thyroid nodules revealed a positive diagnostic HBME immunostaining for PTC and negative CK immunostaining. Any combination of positive diagnostic immunostaining with CK+ HBME, CK+ CD57 or CK+ CD15 has a sensitivity of 95% and specificity of 90% for PTC. Thyroid nodules with a diffuse or focal fine chromatin pattern and focal areas with nuclear grooves or optically clear nuclei displayed immunoreactivity ranging from 0% to 50% of cells. Three of five follicular carcinomas showed negative reactivity for HBME, CD57, and CD15. A combination of immunostaining with CK, HBME and CD57 (or CD15) is a sensitive and specific test for PTC. This panel can be used to rule out thyroid nodules posing a diagnostic problem with PTC. Follicular adenoma and nodules of the thyroid, with a fine chromatin pattern and focal nuclear grooves or optically clear nuclei, displayed an intermediate range of reactivity between reactive thyroid tissue and PTC.
近期的免疫组织化学研究已经鉴定出了不同的抗血清，这些抗血清对甲状腺乳头状癌（PTC）具有不同程度的敏感性和特异性。在本研究中，我们对PTC以及甲状腺良性结节性病变进行了细胞角蛋白（CK）、上皮膜抗原（EMA）、人甲状腺髓样癌单克隆抗体（HBME）、CD57和CD15的免疫染色，以比较这些抗血清对PTC的敏感性和特异性。此外，我们研究了这些抗血清在显示精细染色质模式、核沟细胞灶和光学透明核的良性结节性甲状腺病变中的免疫染色模式。55例PTC（由30例乳头状变体和25例滤泡状变体组成）、5例滤泡状癌、30例滤泡性腺瘤和20例甲状腺结节性病变（5例乳头状变体和15例滤泡状变体）接受了CK、EMA、HBME、CD57和CD15的免疫染色。当将超过10%阳性细胞的任意临界值视为这些血清的阳性诊断免疫染色时，CK和HBME对PTC显示出最高的敏感性和特异性。其他抗血清的敏感性和特异性较低。1例PTC显示HBME阴性但CD15阳性，而3例良性甲状腺结节的乳头状变体和2例滤泡状变体显示出对PTC的阳性诊断HBME免疫染色和CK免疫染色阴性。CK + HBME、CK + CD57或CK + CD15的阳性诊断免疫染色的任何组合对PTC的敏感性为95%，特异性为90%。具有弥漫性或局灶性精细染色质模式以及核沟或光学透明核的局灶区域的甲状腺结节，其免疫反应性在0%至50%的细胞之间。5例滤泡状癌中有3例对HBME、CD57和CD15显示阴性反应。CK、HBME和CD57（或CD15）的免疫染色组合是一种对PTC敏感且特异的检测方法。该组合可用于排除对PTC构成诊断难题的甲状腺结节。具有精细染色质模式以及局灶性核沟或光学透明核的滤泡性腺瘤和甲状腺结节，其反应性介于反应性甲状腺组织和PTC之间。
